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Madagascar: 2018/2019 Measles

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  • Madagascar: 2018/2019 Measles


    Madagascar: Measles Outbreak - Oct 2018 Alert

    Madagascar has been experiencing a measles outbreak since early October 2018. The outbreak started in the urban health district of Antananarivo Renivohitra (in the heart of the capital city, Antanarivo) on 4 October 2018 when three measles cases were confirmed at the Pasteur Institute of Madagascar (IPM) by serology. The disease then spread to other health districts (Tanà South, Tanà North and Ambohidratrimo) in Analamanga Region (where the capital city is located) and subsequently to other parts of the country. The Ministry of Public Health formally declared the measles outbreak on 26 October 2018.

    As of 18 November 2018, a total of 3 239 measles cases have been reported, of which 182 were confirmed immunoglobulin M (IgM) positive and 3 057 were epidemiologically linked. No deaths have been reported to date...

  • #2

    Madagascar measles outbreak grows, 2/3 of cases from Analamanga region
    by News Desk
    December 28, 2018

    In a follow-up on the measles outbreak in Madagascar, local media reports (computer translated) the outbreak case total has risen to 15,049 cases since Oct. 1.

    About 65% of these cases were reported in the Analamanga region. 48 districts in Madagascar are affected by the measles epidemic during the last three months, six of which recorded more than 400 cases...


    • #3
      Translation Google

      Ambato Boeny - Dozens of measles deaths reported

      Ambato-Boeny is the second district heavily affected by the measles epidemic. Local authorities report several dozen deaths in a few months.

      We are witnessing several deaths of measles during our raids in the bush in the last two months. We have seen and heard of at least sixty dead. We even saw three people from the same family, die simultaneously, "said a source at the National Gendarmerie Ambato Boeny yesterday. A source from the National Police of this district indicates, also, that this disease makes several victims, in the chief place of the district. Another source hammers out: "We recorded at least one death a day in the urban district of Ambato Boeny, in two months. Sometimes this number of deaths rises to five per day.
      -------------------------------------------------- -

      Measles outbreak - Population distress call

      January 5, 2019
      Several people from across the island are sounding the alarm about the vulnerability of measles management. A distress call is launched in the face of insufficient inputs, health workers, care infrastructure, the cost of treatment. "If we continue like this, and as long as there are no drastic measures to stop the transmission of this disease, many will die," calls a health staff who remained anonymous. At the Analakininina hospital in Toamasina, ten people are suspected of succumbing to the disease. in Mahajanga, the medical inspector reports three deaths. in Ambato Boeny, local sources speak of a "hundred deaths", in the bush and in the city. In Antananarivo-ville, cases of measles deaths are also notified, without an exact figure. There would also have been deaths in other districts such as Antsohihy, Morondava.
      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela


      • #4
        Translation Google

        Epidemic - Many infants die from measles.

        January 10, 2019. Miangaly Ralitera

        The Ministry of Public Health officially reports the deaths of sixty-seven measles victims. Most are infants.

        Measles has been the cause of death of several infants since the outbreak of the disease, according to the report of the Secretary General of the Ministry of Public Health, Professor Arsene Ratsimbasoa in Ambohidahy yesterday. "90% of these victims are between 9 and 11 months old. They are, generally, unvaccinated children. And they received treatments only late. They were only brought to the hospital when their disease has evolved dramatically, "he describes. These cases have been reported at health facilities in Antananarivo-city, Ambato Boeny, Marovoay, Mahajanga, Toamasina, among others.

        Some have succumbed in a hospital bed, others are corpses in deposit. Community deaths such as those in Anosipatrana, Andoha-tapenaka, and Ambato Boeny are not included in this report.
        "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
        -Nelson Mandela


        • #5
          Measles – Madagascar

          Disease outbreak news
          17 January 2019

          WHO is supporting the Ministry of Public Health of Madagascar to respond to an unusually large measles outbreak. Madagascar last experienced measles outbreaks in 2003 and 2004, with reported number of cases at 62 233 and 35 558, respectively. Since then, the number of reported cases had sharply declined until the current outbreak. From 4 October 2018 to 7 January 2019, 19 539 measles cases and 39 “facility-based” deaths (case fatality ratio: 0.2%) have been reported by the Ministry of Public Health (MoH) of Madagascar. Cases were reported from 66 of 114 total districts in all 22 regions of Madagascar. Among the 19 539 measles cases, 375 have been laboratory confirmed (all are IgM+) and 19 164 were confirmed by epidemiological link. Cases confirmed by epidemiological link are those who presented clinical symptoms based on the case definition and had been in contact with another laboratory confirmed or epidemiologically linked case. The outbreak has spread to densely populated urban cities including Toamasina, Mahajanga, Antsirabe, Toliara and the capital city Antananarivo. Most cases were reported from Analamanga (61%) and Boeny (20%) regions. The highest attack rates were observed in Antananarivo-Renivohitra district (714 per 100 000 inhabitants), and Ambato-Boina district (668 per 100 000 inhabitants), in Analamanga and Mahajanga regions, respectively. These rates are considerably higher compared to the national attack rate of 108 per 100 000 inhabitants.
          In the current epidemic, children aged 1 to 14 years account for 64% of the total number of cases. The age distribution in this group is as follows: under five years at 35%, 5-9 years at 22% and 10-14 years at 19%. Both sexes are equally affected with a male to female ratio of 1.04. The national immunization programme recommends routine measles immunization for children aged nine months. According to WHO and the United Nations International Children’s Emergency Fund (UNICEF), the estimated measles immunization coverage in Madagascar was 58% in 2017. More than half of the cases (51%) reported during the current outbreak have not been vaccinated or have unknown immunization status. Madagascar has the highest proportion of malnutrition among children under five (47%) in the African region which can increase children's risk of serious complications and death from measles infection.
          The circulating genotype for the current measles outbreak in Madagascar is B3, usually found in Africa and Europe. No measles cases with travel history to Madagascar, however, have been reported in neighboring countries and initial investigations in Madagascar have not shown any link with cases from countries with measles outbreak in the Africa region or Europe.
          The measles outbreak has occurred concurrently with the resurgence of plague in the country—which reoccurs seasonally—straining the public health response.
          Public health response

          The Ministry of Public Health of Madagascar is coordinating the response activities, with the support of WHO and other partners. Public Health response measures include:
          • Enhancement of active surveillance (active case finding, community-based surveillance, distribution of specimen collection kits) in all affected districts.
          • Use of the Global Measles Programmatic Risk Assessment Tool to target priority districts for vaccination.
          • Completion of targeted vaccination campaigns:
            • Campaign conducted from 22 October to 9 November 2018 in four districts of Antanavarivo city. The campaign targeted at least 95% of children aged between nine and 59 months. Preliminary results show coverage of 84% of the targeted population.
            • Campaign planned from 14 to 18 January targeting 2 083 734 children aged between nine months and nine years in 25 districts across 13 regions. The campaign is being funded by Measles Rubella Initiative (MRI), the Government of Madagascar, WHO, UNICEF, Catholic Relief Services (CRS), Commission de l'Océan Indien (COI), the United States Agency for International Development (USAID), the Embassy of France in Madagascar and the World Bank and the total cost is US$ 2 355 989.
          • Reinforcement of routine immunization (one dose of measles-containing vaccine (MCV) as per the national immunization programme) for children aged between nine and 11 months.
          • Continued management of severe measles cases in referral hospitals, provided to patients free of charge. Vitamin A is being administered to patients under care in all referral and district health centres.
          • Continued community mobilization with the support of UNICEF and USAID, aiming to increase understanding of the disease as well as uptake of the vaccines from campaigns and routine vaccination.
          • Reactivation by USAID of the 910 hotline, formerly used during the 2017 plague epidemic, for information sharing on measles.
          WHO risk assessment

          Measles is an acute, highly contagious viral disease that has potential to lead to major epidemics. Low coverage with measles vaccine combined with a low incidence of measles in recent years in Madagascar has contributed to a significant proportion of the population which is susceptible to measles. According to WHO and UNICEF estimates, the measles immunization coverage in Madagascar was 58% in 2017. The malnutrition rate is also a contributor as malnutrition increases children's vulnerability of serious complications and death from measles infection.
          WHO estimates the overall risk for Madagascar from this measles outbreak to be very high. Currently, several concomitant factors are likely to hinder or delay public health intervention and might jeopardize the response: post-election conflict, geographical isolation and remoteness of cases, insecurity, hurricane season and multiple outbreaks. Targeted immunization campaigns and strengthening of routine immunization activities are paramount in the effective control of the outbreak. Administration of Vitamin A, specifically in a context of high rates of malnutrition, can reduce illness and deaths from measles infection.
          The risk at the regional level is low although the spread of measles to neighboring Indian Ocean islands and other African countries and Europe cannot be excluded. Strengthening of surveillance in neighboring countries is recommended. The overall global risk is considered to be low.
          WHO advice

          WHO urges all Member States to:
          • Vaccinate to maintain coverage of 95% with two doses of MCV.
          • Vaccinate at-risk populations (without proof of vaccination or immunity against measles and rubella), such as health workers, people working in tourism and transportation (hotel and catering, airports, taxi drivers, etc.), and international travelers.
          • Maintain a reserve of MCV and syringes for control of imported cases in each country in the region.
          • Strengthen epidemiological surveillance of fever or rash cases for timely detection of all suspected cases of measles in public and private healthcare facilities and ensure that samples are received by laboratories within five days of being taken.
          • Provide a rapid response to imported measles cases through the activation of rapid response teams to prevent the establishment or reestablishment of endemic transmission.
          • Administer vitamin A supplementation to all children diagnosed with measles to reduce the complications and mortality (50,000 IU for a child <6 months="" of="" age,="" 100,000="" iu="" for="" children="" 6-12="" months="" of="" age="" or="" 200,000="" iu="" for="" children="" 12-59="" months);="" two="" doses,="" immediately="" upon="" diagnosis="" and="" on="" the="" following="">
          WHO does not recommend any restriction on travel and or trade to Madagascar based on the information available on the current outbreak.
          For more information on Measles, please see the link below: